Academic Journal of Surgery (AJS - Tehran University of Medical Sciences)
Not a member yet
145 research outputs found
Sort by
Evaluating the Reliability of Coagulation Tests in Guiding Surgical Decisions for Spinal Interventions in Post-COVID-19 Patients
Get PDFBackground: The COVID-19 pandemic has introduced challenges in medical practices, impacting laboratorytesting and raising concerns about the reliability of specific tests. This study aimed to assess the reliability ofusing hematology test results to delay surgeries, particularly in spinal interventions.Methods: A retrospective analysis was conducted on the medical records of 220 patients who had undergonespinal surgery between October 2021 and June 2023, and whose COVID-19 status was documented. Inclusioncriteria encompassed individuals without a history of blood disorders, pregnancy, drug or smoking addiction, orrecent surgical procedures. Data analysis utilized SPSS software, employing descriptive methods and statisticaltests such as the independent samples t-test and chi-square test, with statistical significance set at p < 0.05.Results: Among the analyzed patients, 56.4% were male. Fusion surgery was performed on 82.7% of individuals,while laminectomy surgery was performed on 17.3%. Approximately 65.9% had no underlying conditions,and 67.3% had a history of prior COVID-19 infection. Postoperative thrombotic complications were observedin 2.2%. Comparisons between patients with and without coagulation complications revealed no significantdifferences in demographic information, history of COVID-19 infection, or coagulation test results. Furthermore,a comparison of D-dimer test outcomes between individuals with normal D-dimer levels [54 people] and thosewith levels exceeding 500 [55 people] demonstrated no significant distinction (p > 0.05).Conclusions: Based on the findings, this study concludes that, for major and extensive spinal surgeries inpatients with a history of COVID-19, evaluating D-dimer test results does not offer significant assistance indecision-making
Comparison of the Effects of Dexmedetomidine and Remifentanil in Reducing Bleeding During Paranasal Sinus Surgery: A Double- Blind Randomized Clinical Trial
Get PDFBackground: Intraoperative bleeding is a challenge in functional endoscopic sinus surgery (FESS). This studyaimed to compare the effects of Dexmedetomidine and Remifentanil on intraoperative bleeding, hemodynamicstability, and postoperative pain in patients undergoing paranasal sinus surgery.Methods: In this randomized controlled trial, 100 adult patients undergoing paranasal sinus surgery were randomly assigned to receive either Dexmedetomidine (0.2 μg/kg/h) or Remifentanil (0.25 μg/kg/min) bycontinuous intravenous infusion during surgery. General anesthesia was administered in both groups. Theprimary outcome was intraoperative blood loss, assessed both by volume (in milliliters) and bleeding severity(on a 5-point Likert scale). Secondary outcomes included systolic and diastolic blood pressure, heart rate, VisualAnalog Scale (VAS) pain scores, and surgery duration.Results: There was no significant difference in mean intraoperative blood loss between groups(Dexmedetomidine:114.76 ± 1 26.65 mL vs. Remifentanil: 119.20 ± 47.28 mL; p = 0.81). However, bleedingseverity was significantly lower in the Dexmedetomidine group, with 76% experiencing mild bleeding compared to 56% in the Remifentanil group, and 16% in the latter experiencing severe bleeding (p = 0.008). Postoperative VAS pain scores were significantly lower in the Dexmedetomidine group (2.04 ± 0.53 vs. 3.12 ± 1.08; p < 0.001). Hemodynamic parameters decreased substantially over time in both groups, with no clinically significantintergroup differences, except at isolated time points.Conclusions: While both Dexmedetomidine and Remifentanil effectively maintained hemodynamic stabilityduring FESS, Dexmedetomidine resulted in milder bleeding severity and better postoperative analgesia,supporting its use as a preferred agent for controlled hypotension in sino-nasal surgery
Pattern and Predictors of Pediatric Head Injuries Presenting to an Emergency Department in Southeast Iran: A Cross-Sectional Study
Get PDFBackground: Traumatic brain injury (TBI) is one of the leading causes of emergency department admissions and neurological morbidity among children worldwide. Identifying epidemiological trends, mechanisms of injury, and outcome predictors is essential for guiding preventive strategies and improving clinical anagement. This study aimed to evaluate the epidemiological characteristics, mechanisms, and outcomes of pediatric head trauma cases presenting to the emergency department of Khatam-Al-Anbia Hospital in Zahedan, Southeast Iran, during 2022–2023.Methods: This descriptive, retrospective, cross-sectional study included 112 children under 16 years of age withdocumented head trauma. Data were extracted from hospital records using a standardized checklist coveringdemographic variables, mechanism of injury, trauma severity (based on the Glasgow Coma Scale; GCS), andneurological outcome (discharge or death). Consecutive non-probability sampling was applied. Statistical analysis was performed using SPSS version 26.0, employing descriptive statistics and the Chi-square test to explore associations between clinical variables and outcomes.Results: Of the 112 cases, males comprised 76.8%, and the 6–12-year age group accounted for the largest proportion (48.2%). Road traffic accidents were the predominant cause of trauma (54.5%), followed by falls. Regarding injury severity, 50.0% had mild, 26.8% moderate, and 23.2% severe injuries. The overall mortality rate was 4.5%. Although no significant association was found between age or gender and neurological outcomes, injury severity demonstrated a borderline significant relationship with mortality (p = 0.076).Conclusions: Pediatric head trauma remains a major cause of morbidity and mortality in Southeast Iran, predominantly affecting school-aged boys and primarily resulting from road traffic accidents. Injury severity is a key determinant of outcome. These findings highlight the urgent need for enhanced parental education, implementation of school-based safety programs, and strengthening of prehospital and in-hospital trauma caresystems to reduce preventable deaths and improve outcomes
Investigation of Mortality and Morbidity In Patients Associated With Low Anterior Resection and Ghost Ileostomy
Get PDFBackground: Ghost ileostomy is a new invented method that use in patients with low ant resection and colorectal anastomose. Ghost ileostomy can be used instead of converting stoma. CS (converting stoma) is critical after low rectal resection procedures due to its anastomosis leakage preventing role, especially in patients who are at higher risk but its complications are non-negligible. We approached a study of Ghost ileostomy to identify its probable post operation morbidity and mortality. The purpose of this study was to assess the prevalence of some Post operation morbidity such as anastomose bleeding or hematoma, prolong ileus, pulmonary emboly, intra abdominal abscess, wound site infection and other complications.Methods: 26 patients with low ant resection and colorectal anastomosis due to colon cancer without any risk factor between 2013 and 2014 were selected. Checking of anastomosis leakage after 10-14 days post operation was analyzed to assess the prevalence of anastomosis leakage and compare post operation morbidity and mortality.Results: The mean age of cases was 55 years (40 to 65). 16 (61.5%) were male and 10 (38.5%) female. average BMI is 23.7 and all of the patient are in the normal range. Our mortality rate was negative. 2 patients (0.076%) suffered from prolong ileus and one patient (0.038%) had wound site infection. Other post operation morbidities such as anastomose bleeding or hematoma, pulmonary emboly, intra abdominal abscess were negative. We had no any stoma related morbidity and also no any anastomosis morbidity.Conclusion: Anastomosis leakage is the most complication in colorectal surgeries. Diverting stoma can decrease complications of anastomosis leakage but there is no evidence of its preventing role. By using ghost ileostomy we can manage selective loop ileostomy and the complications will be reduced. The most reliable way for anastomosis leakage diagnosis is surgeon's suspicion. Converting stoma that use for preventing anastomosis leakage, has significant complications by its own. As the anastomosis leakage does not have a high prevalence we can use ghost ileostomy to reduce the complications and improving quality of life
Applying Translaryngeal Ultrasonography in Unilateral Vocal Cord Paralysis before Thyroid Cancer Reoperation: A Single Center Study
Get PDFBackground: One of the most dangerous complications of thyroid surgery is recurrent laryngeal nerve (RLN)paralysis. The gold standard method to assess this damage is Videolaryngoscopy. However, we aimed to modifythis approach by using Translaryngeal Ultrasonography (TLUS). We performed TLUS with a highly trainedthyroid sonographer and an endocrine surgeon in 47 patients with recurrent thyroid cancer and unilateral RLNparalysis preoperatively, and compared the results with Videolaryngoscopy. The experienced sonographeridentified 45 injuries in 47 patients, and the endocrine surgeon found 39 vocal cord injuries. It appears thatTLUS, when performed by experienced practitioners, is a more accurate and safe modality for assessing vocalcord function in the preoperative setting of thyroid cancer reoperatio
Acute Aortic and Carotid Dissection Presenting with a Headache, a Case Report
Get PDFBackground: Aortic dissection is an uncommon medical emergency with an incidence rate of approximately three per 100,000 people; the diagnosis of aortic dissection is often missed in the absence of chest pain in approximately 6% of cases.Case Presentation: There was a 53-year-old man with a history of migraines and high blood pressure who woke up in the morning with a severe headache and was diagnosed with carotid dissection and thoracic aortic dissection involving the ascending aorta and descending aorta.Conclusion: Aortic dissections rarely present with severe headaches as their initial symptom, but aortic dissections with carotid artery dissections are typically accompanied by headache; it is important to keep in mind that the sudden onset of a frontal headache may necessitate sonography of the carotid arteries and echocardiography
My first two rhinoplasty surgeries as main operator: Personal experience and considerations by a 2nd year plastic surgery resident
Get PDFIn the present paper, my first two rhinoplasty cases performed as a second-year plastic surgery resident will be presented. The morpho-functional analysis of the patients’ noses, the operative procedures, and the results will be described, highlighting the technical and organizational difficulties encountered and the strengths/safety points. The goal is to help young colleagues like me become acquainted with this complex surgery, characterizing possible initial obstacles and areas for improvement
Suture Granoloma Mimicking Bladder Stone: A Diagnostic Challenge
Get PDFBladder stones are a rare complication of urinary stones, with a higher prevalence in male patients. They can be categorized as primary or secondary, with secondary bladder stones often associated with underlying conditions such as bladder outlet obstruction, urinary tract infections, and foreign bodies. This case report presents the surgical intervention for a 27-year-old woman with a history of mental retardation and asthma who presented with urinary incontinence and other urinary symptoms. Imaging confirmed the presence of a large bladder stone attached to a nylon suture string. The stone was successfully fragmented and removed, and the suture material was cut and extracted. Follow-up showed resolution of symptoms, and the patient was discharged with appropriate medication. This study highlights the association between bladder stones and foreign bodies, particularly suture materials used in vesicle surgeries. Previous studies have reported bladder stone formation related to both absorbable and non-absorbable sutures. This emphasizes the need for further research to investigate preventative measures and the choice of suture materials to minimize the risk of bladder stone formation. It is important for clinicians to be aware of this potential complication when performing bladder surgeries and to consider alternative suturing techniques or materials to reduce the risk of stone formation
Relationship Between Brain CT Scan Findings, Consciousness Levels, and Outcomes in Brain Trauma Patients: A Cross-Sectional Study
Get PDFIntroduction: Trauma ranks as the fourth leading cause of mortality worldwide. Evaluating the consciousness levels of trauma patients involves a range of tools, among which the Glasgow Coma Scale (GCS) holds paramount importance. The GCS is a diagnostic instrument for assessing injury severity and the condition of brain trauma patients. Additionally, Computed Tomography (CT) Scans are the most practical and accurate imaging modality for diagnosing the types and locations of lesions in cases of brain trauma in the emergency department. To this end, the study was designed to explore the correlation between pathological findings in Brain CT scans and the consciousness levels of brain trauma patients, as assessed by the GCS.Methods: This cross-sectional descriptive-analytical study investigated 200 brain trauma patients admitted to the emergency department of Khatam Al-Anbia Hospital in Zahedan. Upon arrival, an emergency medicine specialist recorded the patients' consciousness levels based on the GCS criteria. After performing a CT scan and determining the type and location of the lesion, a radiologist, emergency medicine, and neurosurgery specialists have determined the continuation of the treatment process. Subsequently, patients requiring admission to the neurosurgery department or intensive care unit were monitored. The final patient status (deceased/survivor) was tracked at the end of the treatment period and added to the checklist. Following data coding and entry into the computer, descriptive statistics, including mean, standard deviation, and confidence intervals, were used for evaluation. Additionally, the Chi-square and independent t-tests, along with SPSS 22, were employed to examine the relationship between consciousness levels and CT scan results.Results: Three out of 200 patients were excluded from the study due to transfers to other medical facilities during treatment. The mean age of the remaining patients was 27.94 ± 11.25. Results showed that 67.5% of all patients survived, while 32.4% succumbed to injuries. The initial GCS score was 14-15 for 83 patients (42.1%), 9-13 for 69 patients (35%), and 3-8 for 45 patients (22.8%). Brain CT scans of trauma patients predominantly revealed subdural hematomas in 48 patients (24.3%). In the examination of the relationship between the mechanism of brain trauma and mortality, 75% of patients involved in falls and 65.5% in accidents survived, while all patients who experienced other causes of trauma survived. Ultimately, no significant difference was observed between the mechanism of brain trauma and patient mortality (p=0.318). Furthermore, all patients with a GCS score of 14-15 (100%), 85.6% with a GCS score of 9-13, and 35.5% with a GCS score of 3-8 survived. A significant relationship between initial consciousness levels and mortality rates in the emergency department was evident (p=0.001). Statistical analysis indicated that 66.7% of patients with subdural hematomas, 75% with epidural hematomas, 81% with cerebral contusions, 35.3% with intracerebral hemorrhages (ICH), and 92.3% with diffuse axonal injuries (DAI) ultimately survived, signifying a significant relationship between CT scan results and mortality rates (p=0.01). Moreover, the highest mortality rate was observed in patients with ICH, with a frequency of 64.7%.Conclusion: Simultaneously evaluating consciousness levels using the GCS, along with considering the type of pathology identified in CT scans of brain trauma patients admitted to the emergency department, significantly aids in determining patient mortality rates. Promptly initiating the patient's treatment process can lead to reduced complications from brain trauma and, in some cases, decreased mortality
The Association of Abdominoplasty with Breast Reduction (Mommy Makeover): Experience in An African University Hospital
Get PDFIntroduction: The popularity of breast reduction and abdominoplasty has increased significantly over the years according to statistics from the American Society of plastic surgeons 2022. As a result, Mommy Makeover, or the procedure combining breast surgery and abdominoplasty, is not uncommon.
Patients and methods: A retrospective descriptive study that took place over a four-year period within the plastic and aesthetic surgery department of the IBN SINA UNIVERSITY HOSPITAL, Rabat, Morocco.
Results: 5 cases of Mommy Makeover operated within the plastic and aesthetic surgery department of the IBN SINA UNIVERSITY HOSPITAL, Rabat, Morocco. One case a was addressed two years after bariatric surgery. The procedure combined Breast reduction with the superior-internal pedicle technique with Wise’s pattern and abdominoplasty. No major complication was observed.
Discussion: Since the appearance of abdominoplasties combined with breast surgery, several concerns are related to this association. Venous thromboembolism is the most commonly discussed consequence in combined plastic surgery procedures. The risk of venous thromboembolism is not elevated when abdominoplasty and breast reduction are combined.
The study emphasizes the significance of cautious patient selection and attentive venous thromboembolism prevention. assess the validity of the Davison-Caprini framework for venous thromboembolism risk stratification and prophylaxis in plastic surgery. Other measures to prevent complications were cited in the literature and followed by our operating team.
Conclusion: With the help of a simple risk stratification tool that takes into account diabetes, age, BMI and ASA status, we can guarantee favorable results for women who may want combined surgery.
Introduction: The popularity of breast reduction and abdominoplasty has increased significantly over the years according to statistics from the American Society of plastic surgeons 2022. As a result, Mommy Makeover, or the procedure combining breast surgery and abdominoplasty, is not uncommon.
Patients and methods: A retrospective descriptive study that took place over a four-year period within the plastic and aesthetic surgery department of the IBN SINA UNIVERSITY HOSPITAL, Rabat, Morocco.
Results: 5 cases of Mommy Makeover operated within the plastic and aesthetic surgery department of the IBN SINA UNIVERSITY HOSPITAL, Rabat, Morocco. One case a was addressed two years after bariatric surgery. The procedure combined Breast reduction with the superior-internal pedicle technique with Wise’s pattern and abdominoplasty. No major complication was observed.
Discussion: Since the appearance of abdominoplasties combined with breast surgery, several concerns are related to this association. Venous thromboembolism is the most commonly discussed consequence in combined plastic surgery procedures. The risk of venous thromboembolism is not elevated when abdominoplasty and breast reduction are combined.
The study emphasizes the significance of cautious patient selection and attentive venous thromboembolism prevention. assess the validity of the Davison-Caprini framework for venous thromboembolism risk stratification and prophylaxis in plastic surgery. Other measures to prevent complications were cited in the literature and followed by our operating team.
Conclusion: With the help of a simple risk stratification tool that takes into account diabetes, age, BMI and ASA status, we can guarantee favorable results for women who may want combined surgery